|Year : 2015 | Volume
| Issue : 7 | Page : 74-75
Unique case from real life practice
Consultant Endocrinologist, Hinduja National Hospital; Consultant Endocrinologist, Hope and Care Centre, Vashi, Navi Mumbai, Maharashtra, India
|Date of Web Publication||17-Apr-2015|
Consultant Endocrinologist, Hope and Care Centre, Vashi, Navi Mumbai., Maharashtra
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Type 1 diabetes mellitus (T1DM) is a form of diabetes mellitus that results from the autoimmune destruction of the insulin-producing beta cells in the pancreas. For economically backward children, understanding and dealing with the disorder can be quite challenging. Here, I describe a female with T1DM and how her enrolment into the changing diabetes in children program brought about a positive change for her. Financial, medical and psychological support at the right time will help these children to gain independence.
Keywords: Changing diabetes in children, diabetes, type 1 diabetes
|How to cite this article:|
Chadha M. Unique case from real life practice. Indian J Endocr Metab 2015;19, Suppl S1:74-5
| Introduction|| |
Type 1 diabetes (T1D), although less common than type 2 diabetes, is increasing each year, particularly in children under the age of 15 years. The overall annual increase is estimated to be around 3%.  In most high-income countries, the majority of diabetes in children and adolescents is T1D. Around 79,100 children under 15 years are estimated to develop T1D annually worldwide. Of the estimated 497,100 children living with T1D, 26% live in the Europe Region, and 22% in the North America and Caribbean Region. 
In T1D, insulin therapy is life-saving and lifelong. A person with T1D needs to follow a structured self-management plan, including insulin use and blood glucose monitoring, physical activity, and a healthy diet. In many countries, especially in developing countries, access to self-care tools, including self-management education, as well as to insulin, is limited. This leads to severe disability and early death. Many children and adolescents find it difficult to cope emotionally with their disease. Diabetes results in discrimination and may limit social relationships. It may also have an impact on a child's academic performance. The costs of treatment and monitoring equipment, combined with the daily needs of a child with diabetes, may place a serious financial and emotional burden on the whole family. 
A 13-year-old girl presented to us with diabetic ketoacidosis (DKA). At the time of hospitalization under the changing diabetes in children (CDiC) program, it was told that she had been symptomatic for 2 months prior to her hospitalization. She was from a low socioeconomic family, born of a nonconsanguineous marriage and was third of her four siblings. There was no known family history of diabetes mellitus. She was studying in VII standard and was doing pretty well scholastically. She was being looked after by a single mother who worked as a cook in multiple households.
Prior to her admission, she was being advised by a private physician to take three doses of regular insulin daily. However, she could manage at the best two doses daily. Later on she used to have only a single morning dose. Her self-monitoring of blood glucose was also almost negligible. Also, she underwent alternate forms of therapy before starting allopathic treatment which further worsened her condition as they contributed to the development of DKA. She was unable to follow any medical advice and underwent repeated hospitalization for severe hyperglycemia or DKA. She had delayed puberty. There was a loss of work hours for the mother. Her siblings' health also suffered. Thus, there was a health and economic fallout for the entire family.
She was informed about the CDiC program from a family physician. The CDiC program was started by Novo Nordisk in 2011.  She joined the group as a late entrant and signed up at the Hope and Care Centre. Her life took a positive turn after joining the CDiC program.
At the time of registration her weight was 31 Kg and height was 143 cm. She was having prepubertal sexual staging and was suffering from koilonychia and angular stomatitis. Her systemic examination was insignificant. Further laboratory investigations showed the following parameters: Haemoglobin (Hb): 9.4 g%, fasting plasma glucose (FPG): 212 mg% and postprandial plasma glucose (PPPG): 351 mg%, hemoglobin A1c (HbA1c): 11.2%, creatinine: 0.6 mg %, thyroid stimulating hormone (TSH): 1.2 IU/L and thyroxine (T4): 4.5 mcg/dL. Here urine proteins were also negative.
The CDiC program provided her several health benefits which included regular availability of insulin, availability of glucometer and strips for monitoring and further guidance and information on management of her diabetes. She made regular visits to the center, due to which her HBA1c levels improved. Laboratory investigations performed over a period of 1-year showed better results: Hb: 10.6 g, FPG: 133 mg%, PPPG: 171 mg %, HbA1c: 8.6%, creatinine: 0.6 mg %, proteins: 6.7 g%, albumin: 3.5 g% and urine proteins: Negative. There was an overall improvement in her physical and mental well-being.
Her academic performance significantly improved as she was able to attend school regularly. She also got considerable support from school teachers. As a result, she showed an outstanding performance in the board exams. At the same time her family economic condition also improved as her mother was able to work regularly. She doesn't have to pay health bills. There was a regular flow of wages.
At the end of 2 years, her physical condition improved tremendously. She gained considerable weight (36.3 kg) and height (154.6 cm). She underwent puberty (Tanner Stage 3 sexual staging). Koilonychia had totally disappeared. Her HbA1c levels improved further (7.2%). Other laboratory parameters were also found to be normal: Hb: 11.2 g%, FPG: 112 mg%, PPPG: 176 mg %, creatinine: 0.6 mg %, TSH: 1.0 IU/L and T4: 7.8 mcg/dL. Due to her improved health status she was able to plan her future. She aspires to become a diabetes educator and want to help other diabetic children.
Public partners or contributors at CDiC are thinking about a long term strategy; they are planning to introduce a counsellor in the CDiC team who can bring about further changes, from a nonmedical perspective. They also aim to sensitize teachers and friends about Type 1 Diabetes mellitus.
| Summary|| |
Changing diabetes in children is a great boon for economically backward children. Attempts should be made to identify children who are academically sound. Financial, medical and psychological support at the right time will help these children to gain independence in the actual sense.
| References|| |
DIAMOND Project Group. Incidence and trends of childhood Type 1 diabetes worldwide 1990-1999. Diabet Med 2006;23:857-66.
International Diabetes Federation. IDF Diabetes Atlas. 6 th
ed. Brussels, Belgium: International Diabetes Federation; 2013. Available from: http://www.idf.org/diabetesatlas. [Last accessed on 2014 Sep 19].